Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors

Abstract

Background At the time of recurrence, many borderline ovarian tumor (BOT) patients are still young with fertility needs. The purpose of this study is to evaluate the reproductive outcomes and recurrence rate of second fertility-sparing surgery (FSS) in women with recurrent BOTs. Methods Seventy-eight women of childbearing age diagnosed with recurrent BOTs from November 2009 to 2020 whose primary treatment was FSS were included. Results The FIGO stage I disease accounted for 46.2% and serous BOT accounted for 87.2% in the study group. Forty-seven patients underwent second FSS, and the remaining 31 underwent radical surgery (RS). Seventeen patients relapsed again after second surgery, but no malignant transformation and tumor-associated deaths were reported. Compared to FIGO stage I, the FIGO stage III tumors were more likely to relapse, but there was no statistical difference in pregnancy rate among patients with different stages. In the second FSS group, recurrence rate was higher in patients who underwent oophorocystectomy compared to patients with unilateral salpingo-oophorectomy (USO), but the pregnancy rate was similar. There was no significant difference in postoperative recurrence risk between USO and RS. The recurrence rate was not associated with operative route (laparoscopy or laparotomy), or lymphadenectomy, or postoperative chemotherapy. Among the 32 patients who tried to conceive, the pregnancy rate was 46.9% and live birth rate was 81.3%. Conclusion Unilateral salpingo-oophorectomy is a safe procedure for FIGO stage I recurrent BOT patients with fertility needs, and can achieve a high postoperative pregnancy rate and live birth rate.

Fertility and Pregnancy Outcomes after Fertility-Sparing Surgery for Early-Stage Borderline Ovarian Tumors and Epithelial Ovarian Cancer: A Single-Center Study

“…Because recurrence may occur in patients with BOTs while they are still young and wishing to conceive someday, a second FSS may be performed after thorough consultation. Wang et al confirmed that a second FSS was as safe as radical surgery for recurrent BOTs with a pregnancy rate of 46.9% and a live birth rate of 81.3% [25]. In our study group, 8 of 71 patients with BOTs experienced tumor recurrence.…”

Safety of assisted reproductive techniques in gynecological cancer patients

“…This has also been observed in stage I sex cord stromal tumors [17] and, regardless of tumor stage, in BOT [18,19] and germ cell tumors [20]. Even a second fertility-sparing surgery could be considered safe in BOT after relapse following initial conservative surgery if pregnancy has not yet been achieved [21].…”

Fertility‐sparing management of stage IIIC serous borderline ovarian tumor: A case report of a 20‐year follow‐up

“…After a second fertility‐sparing procedure, 15 patients (32%) had a second recurrence. FIGO stage III is an independent prognostic factor for the second recurrence 12 …”

“…FIGO stage III is an independent prognostic factor for the second recurrence. 12 Patients desiring fertility-sparing procedures should be referred to an appropriate fertility specialist. The patient in this case wanted to become pregnant after the fourth surgery.…”